There is increasing recognition that Thyroid Cancer represents a group of diseases with a broad spectrum of malignant behavior, ranging from the indolent papillary microcarcinoma carrying essentially no risk to the patients health of life; to Anaplastic Thyroid Cancer, the most aggressive human malignancy. The majority of our patients lie between these two extremes and their clinical management must increasingly be predicated on the threat that the disease represents to the patient. This Precision Medicine approach to thyroid cancer management is supported by an increasing weight of evidence, based on improved understanding of the genetic underpinnings of thyroid cancer; long-term studies of outcomes following surgery, radioactive iodine and TSH suppression therapy; and, increasingly, clinical trials of systemic therapy and targeted therapy. True current game changers in the management of thyroid cancer include:
1. Improved diagnostics based on standardized cytopathology reporting; integration of clinical, radiological, cytological and molecular information;
2. Tailored surgical approaches, ensuring that the punishment fits the crime, offering active surveillance for the lowest risk cancers; lobectomy; total thyroidectomy; and more extensive dissections where these are necessary;
3. Improved understanding of the role of Radioactive Iodine administration;
4. Evidence-based surveillance and monitoring algorithms;
5. Use of systemic therapy for advanced and progressive thyroid cancer; and
6. The recognition that clinical trials are not only possible, but are essential for continued improvements in our cost-effective, patient-centric management of thyroid cancer.
This presentation will review the evidence basis for a true precision medicine approach to thyroid cancer diagnosis and management, and will highlight areas where International Guidelines are likely to continue to evolve to support this approach.